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The Gallbladder is the mansion of purity and tranquility, functioning in coordination with the Liver (Gan, 肝), and deriving its source from the Kidney (Shen, 肾). When Yin and Yang are harmonious, opening and closing are appropriate, and movement and stillness are suitable. During the day, it performs the function of Qian (Heaven, 乾) which is active and vigorous; at night, it embodies the meaning of Kun (Earth, 坤) which is quiet and receptive. If turbid Qi, such as Fire Evil (Huoxie, 火邪) or Phlegm-Dampness (Tanshi, 痰湿), disturbs this balance, insomnia occurs. If there is a lack of clear Qi, akin to the sky and sun failing to ascend, excessive sleepiness results. Furthermore, individuals with weak Po (Corporeal Soul, 魄) of the Lung Metal (Feijin, 肺金) and uncontrolled Hun (Ethereal Soul, 魂) of the Liver may experience flying spirits during sleep. Those whose Liver is affected by Excess Pathogens (Shixie, 实邪), causing hyperactive dispersing and draining functions, fail to consolidate and store, leading to the Hun not returning to the Liver. There are cases of Heart Yin Deficiency (Xin Yin Xu, 心阴虚) preventing sleep, cases of Stomach Disharmony (Wei Buhe, 胃不和) causing restless sleep, and cases of Kidney Essence Exhaustion (Shen Shen Xia Jie, 肾神下竭) with Heart Fire Flaring Up (Xin Huo Shang Yan, 心火上炎) resulting in irritability and restlessness. By analyzing pulse conditions item by item, how can one miss the true nature of the disease?

The Classic states: "The Stomach is the sea of the Six Fu Organs; its Qi descends. If Yangming Qi rebels and cannot follow its proper path, one cannot lie down." It also says: "When the Stomach is disharmonious, sleep is uneasy." Sleep involves Yang ascending and Yin descending. When Stomach Qi rebels upward, it obstructs the Lungs, causing noisy breathing, and fails to descend via the Yin pathway, hence restless sleep. It further states: "Panting when lying down indicates the invasion of Water Qi (Shuiqi, 水气)." The root of water diseases lies in the Kidney, while the branch lies in the Lungs; thus, inability to lie flat and panting upon lying down indicate that both root and branch are diseased. These are all instances described in classics where illness causes inability to sleep, but they do not discuss inability to sleep as a primary disorder itself. Another passage from the Classic states: "When Wei Qi (Defensive Qi, 卫气) cannot enter Yin, it remains in Yang. Remaining in Yang leads to fullness of Yang Qi; fullness of Yang Qi leads to exuberance of the Yang Qiao Vessel. Inability to enter Yin results in deficiency of Yin Qi, hence the eyes remain open (insomnia). Moving through Yang leads to wakefulness; moving through Yin leads to sleep. This is the normal state. Deviation from this norm prevents the tranquil storage of the Hun, resulting in inability to close the eyes." This text generally discusses Wei Qi's failure to enter Yin causing insomnia, but does not fully elaborate on the profound principle of Heart-Kidney Spirit interaction and entering Yin. If the Heart governs Blood and stores the Spirit, and if Primordial Yin (Yuanyin, 元阴) is insufficient, it cannot generate Blood. With little Blood, the Spirit has no foundation. The human Spirit resides in the Heart when awake and returns to the Kidney when asleep. Thus, sleep is the process of the Heart Spirit returning to the residence of the Kidney. If the Heart is deficient, the Spirit cannot return to the Kidney's residence, so sleep cannot be achieved. However, if the Kidney is deficient, it cannot store and accept the Heart Spirit into its residence, so sleep is not deep nor lasting. Therefore, in youth, when Kidney Yin is robust, sleep is deep, sound, and long; in old age, when Yin Qi declines, sleep is light and short. Moreover, when tangible Yin Water is depleted, intangible Ministerial Fire (Xianghuo, 相火) flares wildly, causing the scattering of Spirit and Soul, leading to restless sleep. Thus, although insomnia and forgetfulness seem to be Heart disorders, they are often actually caused by Kidney deficiency. This is the theory of Zhang Jingyue (Zhang Xinqiu), supplementing previous omissions.

The Ling Shu states: "When Yang Qi is exhausted and Yin Qi is abundant, the eyes close (sleep); when Yin Qi is exhausted and Yang Qi is abundant, one wakes up." Therefore, at midnight, when all people sleep, it is called "Conjunction of Yin" (Heyin, 合阴), because at this time Wei Qi has exhausted and Ying Qi (Nutritive Qi, 营气) is flourishing. After midnight, Yin Qi is exhausted and Yang Qi becomes abundant, so people tend to wake up. Elderly people with Yin Deficiency are particularly prone to this condition, which is why Shaoyin Disease presents as drowsiness and desire to sleep.

Generally, if Wei Qi travels alone in Yang, Yang Excess and Yin Deficiency lead to insomnia; if Wei Qi remains trapped in Yin for a long time, Yin Excess and Yang Deficiency lead to hypersomnia. This is a definitive conclusion. Therefore, prolonged sitting, late-night banquets, and excessive mental labor cause insomnia because Wei Qi remains in Yang, leading to Yang fullness and Yang activity, illustrating the principle clearly. However, some suffer from excessive mental labor or sexual exhaustion, causing an intangible Yin deficiency within their thoughts and spirit, allowing Deficient Fire to attack the Heart. They may suffer from day-and-night insomnia for months, and even when sleeping, feel vague and restless. Such cases require clearing the mind, stopping distracting thoughts, and internal observation to nourish the Spirit. If using Yin-nourishing herbs triggers nocturnal emissions, it indicates that the Fire within the Spirit has descended, which is indeed a good sign. One should not doubt this and change medications. Some individuals have robust physiques but exhibit symptoms of running away and madness, seemingly indicating excess Phlegm-Fire. Using cold-cooling agents like Gardenia (Zhizi, 栀子), Phellodendron Bark (Huangbai, 黄柏), Scutellaria Root (Huangqin, 黄芩), Coptis Rhizome (Huanglian, 黄连), and Anemarrhena Rhizome (Zhimu, 知母) may cause the Fire to flare up more intensely. This is precisely due to Fire stirring within the spirit-mind, while True Water (Zhen Shui, 真水) is insufficient to control it. Prescribers who do not seek the underlying cause will find no effect. One must rescue/nourish Kidney Water, and the Fire will subside naturally. This corresponds to the Nei Jing saying: "Treating with Cold [herbs] does not reduce heat, because there is no Water [Yin]."